What is ICD-10 code E78.9?

E78.9 is the ICD-10-CM diagnosis code for Disorder of lipoprotein metabolism, unspecified. A general diagnosis of a disorder affecting how the body processes lipoproteins and fats in the blood when the specific type cannot be determined. E78.9 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E78.9 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E78.9 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E78.9 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for E78.9?

E78.9 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards E78.9 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

What should coders know when reporting E78.9?

This is a non-specific code; use only when no more specific E78 code can be assigned Attempt to obtain lipid panel results and specialist evaluation to assign a more specific code

E78.9: Disorder of lipoprotein metabolism, unspecified — ICD-10

ICD-10-CM Code View

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Code lookupE78.9Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)

E78.9

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Disorder of lipoprotein metabolism, unspecified

A general diagnosis of a disorder affecting how the body processes lipoproteins and fats in the blood when the specific type cannot be determined.

Buddy Insight

Disorder of lipoprotein metabolism, unspecified is a nonspecific code indicating an identified lipoprotein metabolism problem without further characterization.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 47

Disorders of Fatty-Acid and L...

RAF 0.0

Code Trumping

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Code Book Path

Official

E78Disorders of lipoprotein metabolism and other lipidemias

E78.9Disorder of lipoprotein metabolism, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E78.9 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E78.9 in this effective period.

Related Child Codes

Official

E78.0Pure hypercholesterolemia

E78.1Pure hyperglyceridemia

E78.2Mixed hyperlipidemia

E78.3Hyperchylomicronemia

E78.4Other hyperlipidemia

Includes

Official

ICD-10-CM does not list Includes notes for E78.9 in this effective period.

Excludes 1

Official

sphingolipidosis (E75.0-E75.3)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E78.9 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E78.9 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E78.9 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider statement confirming a lipoprotein metabolism disorder

Any available lipid panel or lipoprotein testing results

Reason specificity is not documented

Current treatment if any

MEAT Support

HCC Buddy guidance

Provider statement confirming a lipoprotein metabolism disorder

Any available lipid panel or lipoprotein testing results

Reason specificity is not documented

Current treatment if any

Audit Caution

HCC Buddy guidance

Accepting this highly nonspecific code when lipid panel results in the chart could support a specific diagnosis

Not querying the provider when the medical record contains treatable lipid findings

Using E78.9 when the provider writes 'dyslipidemia' — query for what type of dyslipidemia

Assuming any lipid disorder code carries HCC value — the entire E78 category is non-HCC for V24 and V28

Common Mistakes

HCC Buddy guidance

E78.5 — Hyperlipidemia, unspecified: specifically for elevated lipids, slightly more specific than E78.9

E78.00-E78.49 — Specific lipid disorder codes: always preferred when documentation supports

E78.6 — Lipoprotein deficiency: for LOW lipoprotein conditions

E78.89 — Other lipoprotein metabolism disorders: for identified but not elsewhere classified conditions

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is E78.9 an HCC code?

No. E78.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 47, Disorders of Fatty-Acid and Lipid Metabolism

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for E78.9

For E78.9to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E78.9 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E78.9 is the ICD-10-CM diagnosis code for disorder of lipoprotein metabolism, unspecified. A general diagnosis of a disorder affecting how the body processes lipoproteins and fats in the blood when the specific type cannot be determined. E78.9 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E78.9 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

E78.9 maps only to RxHCC 47 (Disorders of Fatty-Acid and Amino-Acid Metabolism) with no RAF weight. No V24 or V28 CMS-HCC mapping. This is one of the lowest-value codes from a risk adjustment perspective, with zero impact on Medicare Advantage RAF scores.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a non-specific code; use only when no more specific E78 code can be assigned
•Attempt to obtain lipid panel results and specialist evaluation to assign a more specific code

Clinical Significance

Disorder of lipoprotein metabolism, unspecified is a nonspecific code indicating an identified lipoprotein metabolism problem without further characterization. This is a low-value code from both clinical and risk adjustment perspectives, and should prompt queries for diagnostic specificity to guide appropriate treatment.

Documentation Requirements

✓Provider statement confirming a lipoprotein metabolism disorder
✓Any available lipid panel or lipoprotein testing results
✓Reason specificity is not documented
✓Current treatment if any
✓Plan for further characterization of the lipid disorder

Commonly Confused Codes

•E78.5: Hyperlipidemia, unspecified: specifically for elevated lipids, slightly more specific than E78.9
•E78.00-E78.49: Specific lipid disorder codes: always preferred when documentation supports
•E78.6: Lipoprotein deficiency: for LOW lipoprotein conditions
•E78.89: Other lipoprotein metabolism disorders: for identified but not elsewhere classified conditions
•E88.9: Metabolic disorder, unspecified: even broader and should not be used when lipoprotein involvement is known